1. Creighton University College of Nursing, Omaha, NE
Palliative Care in Heart Failure Management: Identification of Barriers
Kali F. Kleinsasser RN, BSN, Haley L. Nunes RN, BSN, Allison M. Tamm RN, BSN
Creighton University College of Nursing, Omaha, NE
INTRODUCTION
RESULTS
Response rate was 9.5% = 6 completed surveys.
Survey respondents included 5 MDs/DOs and 1 NP.
100% agreed with the guideline to consult PC for Stage D (symptomatic advanced) HF.
83% agreed with the guideline to consult PC when being considered for a cardiac transplant or medical circulatory support device.
83% trust PC has appropriate discussions about end of life in HF patients.
50% believed they could provide the same discussion that PC providers could regarding quality of life.
When to consult PC: 17% when the patient wanted to discuss end of life wishes, 33% when there was nothing left to do for the patient, and 50% selected “other.” The “other” category stated : (1) In many Stage C and all Stage D patients; (2) all of the above, which includes when the patient is diagnosed with HF, when the patient wants to discuss end of life wishes, and when the provider feels there is nothing left to do for the patient; and (3) discussions should start with the diagnosis of HF (either PCP or Cardiologist).
Heart failure (HF) is the leading cause of death in the United States and unfortunately there is no cure for the disease. A mainstay of therapy focuses on symptom management and quality of life, which involves palliative care (PC) as a necessary component. But, the underutilization of PC in HF is alarming and deserves attention. Despite the clear benefits of PC, HF patients do not receive the PC consults they need and deserve (Thomas, O’Leary, and Fried, 2009 & Bakitas et al., 2013).
The most common barriers revealed in the literature review were (1) unpredictable disease trajectory and prognosis; (2) lack of communication; and (3) lack of coordination and continuity of care.
A gap identified in the literature review revealed there was not concrete evidence on what interventions are proven to overcome the common barriers identified.
The aim of the quality improvement project was to (a) identify the barriers to utilization of PC services and (b) identify interventions to overcome those barriers.
RESULTS: IDENTIFIED INTERVENTIONS
50% -More education to providers
33% -Pay for performance incentive
17% -Other = Increase palliative care staff
MATERIALS AND METHODS
Subject & Design
A quality improvement project was completed using a convenience sample of 6 providers consisting of cardiologists and HF specialists. A mixture of Doctors of Medicine (MDs), Doctors of Osteopathic Medicine (DOs), Nurse Practitioners (NPs), and Physician Assistants (PAs) were included. The sample was taken from two different Midwest hospitals.
Measurement
A brief fourteen point multiple choice survey was developed and disseminated to the target population via Survey Monkey. The providers were given 30 days to complete the survey with two reminder s sent. Data was gathered from the responses in Survey Monkey and transferred to an Excel spreadsheet using descriptive statistics.
CONCLUSIONS
Research has shown the numerous benefits of PC to the HF population.
The major barrier identified in this project was difficulty coordinating a PC consult.
The major intervention identified to overcome the barriers were to educate all providers about the benefits of PC.
Adult Gerontology Acute Care Nurse Practitioners (AG-ACNP) have the ability to oversee care and foster a smooth transition between levels of care. They are trained as a care coordinator and an educator, which allows them to educate providers regarding the benefits of PC.
Future research should focus on identifying barriers and interventions to increase PC consultations as well as identifying the effectiveness the AGACNP has in closing the gap with coordination of care in HF patients.
ACKNOWLEDGEMENTS
We would like to thank Dr. Lindsay Iverson with her assistance and guidance for this project.
We would also like to thank the providers at the University of Colorado Hospital and Essentia Health for their participation.
RESULTS: IDENTIFIED BARRIERS
50% -Difficulty with coordination and continuity of care
33% -Unpredictable disease trajectory
17% -Lack of communication in the healthcare system
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